Experts Say Hypochondria Is Real

B O S T O N, Nov. 9

By Melinda T. Willis

The recent anthrax scares have made nearly everyone a little more worried about those sniffles and coughs, leading many people to joke about hypochondria. But experts say hypochondriasis is a real disorder that puts a strain on the medical system and is no laughing matter.

A person who suffers from hypochondriasis believes that his or her physical symptoms, either real or imagined, are signs of a much more serious illness, despite medical reassurance that they are not. According to experts, the prevalence of hypochondria ranges from 4 percent to 7 percent in the general population, affecting both men and women equally.

"Most people who notice a mole on their shoulder that is changing color [and] that they think may be skin cancer will go to the doctor who tells them that it is nothing. And they say, 'Great, I'm outta here,' says Dr. Arthur Barsky, director of psychiatric research at Brigham and Women's Hospital in Boston, who reviews hypochondriasis in this week's issue of The New England Journal of Medicine. "That sort of information and reassurance is not helpful to a person suffering from hypochondriasis."

Instead, a hypochondriac will become angry with the physician for failing to realize that the person does indeed have a problem, says Barsky.

Some research suggests hypochondriacs may be more finely tuned to their bodies and have a tendency to misinterpret symptoms that others would overlook.

"Hypochondriacs tend to [believe they] suffer from diseases that aren't always clear and where a diagnosis is often difficult," says Dr. Brian Fallon, director of the Somatic Disorders Research Program at the New York State Psychiatric Institute.

Poorly Understood

Although hypochondriasis is a very common problem in clinical practice, Barsky notes there isn't much known about how to deal with it.

While hypochondriasis is regarded as a psychiatric disorder, psychiatrists rarely see patients who suffer from it. From the perspective of the patients, their problems are a medical concern and they are generally very reluctant to see a mental health professional if their physician suggests it.

"That's like saying they're making it up," says Fallon.

As a result, hypochondriacs become a huge drain on the medical system. "They are very expensive to take care of," says Barsky. "They use a disproportionate amount of services and it doesn't do any good. They are not assured."

Hypochondriacs have disproportionately high rates of visits to physicians, specialty consultations, surgical procedures and lab tests.

Treatment Options

One treatment strategy for hypochondriasis is cognitive-behavioral therapy in which patients try to alter their beliefs about illness and symptoms and seek to understand how their behaviors play a role in the disorder.

A second strategy is pharmacotherapy or treatment with medications such as Prozac.

According to Barsky, two-thirds of hypochondriacs have co-existing psychiatric illnesses such as major depression, panic disorder, and obsessive-compulsive disorder. Treatment of these underlying conditions has been shown to alleviate hypochondriasis.

Additional research by Fallon shows that regardless of whether there is an underlying condition, hypochondriacs can be treated with medication.

"Seventy to 80 percent of people who have hypochondriasis benefit significantly from pharmacological treatment," says Fallon.

Other strategies include developing supportive relationships between physicians and patients and using techniques to assure the patient their concerns are being regarded.

"The good news about hypochondriasis is that it's treatable," adds Fallon.